Evidence Review: Religious Marginalities and COVID Vaccination - Access and Hesitancy

Religious minority affiliation or status can play a very important role in influencing people's access to vaccines as well as their willingness to undergo vaccination. Many studies focus on class, ethnicity and geographic location when examining how social inequalities impact vaccination programmes. However, religious marginality is often overlooked. Here we explore how being situated on the margins, on account of religious affiliation, shapes experiences of vaccine access and uptake. The issues addressed are important for COVID-19 vaccination roll out, but also contain lessons for all vaccination programmes and many other preventative health measures. In this brief, we present key considerations for addressing differentials in access to and willingness to undergo vaccinations that are linked to religious minority status, experiences, authorities or doctrine. We explain why the study and awareness of religious marginality is crucial for the success of vaccination programmes broadly and specifically as they apply to COVID-19 vaccination. We also explore ways in which religious marginality intersects with other identity markers to influence individual and community access to vaccines. Finally, we examine vaccine hesitancy in relation to religious minorities and outline approaches to community health engagement that are socio-religiously sensitive, as well as practical, to enhance vaccination confidence.

Evidence Review: Religious Marginalities and COVID Vaccination - Access and Hesitancy

Religious minority affiliation or status can play a very important role in influencing people's access to vaccines as well as their willingness to undergo vaccination. Many studies focus on class, ethnicity and geographic location when examining how social inequalities impact vaccination programmes. However, religious marginality is often overlooked. Here we explore how being situated on the margins, on account of religious affiliation, shapes experiences of vaccine access and uptake. The issues addressed are important for COVID-19 vaccination roll out, but also contain lessons for all vaccination programmes and many other preventative health measures. In this brief, we present key considerations for addressing differentials in access to and willingness to undergo vaccinations that are linked to religious minority status, experiences, authorities or doctrine. We explain why the study and awareness of religious marginality is crucial for the success of vaccination programmes broadly and specifically as they apply to COVID-19 vaccination. We also explore ways in which religious marginality intersects with other identity markers to influence individual and community access to vaccines. Finally, we examine vaccine hesitancy in relation to religious minorities and outline approaches to community health engagement that are socio-religiously sensitive, as well as practical, to enhance vaccination confidence.

Willingness and SARS-CoV-2 Vaccination Coverage among Healthcare Workers in China: A Nationwide Study

Background: The SARS-CoV-2 vaccine has been widely rolled out globally in the general populations. However, specific data on vaccination confidence, willingness or coverage among health care workers (HCWs) has been less reported. Methods: A cross-sectional online survey was conducted to specify the basic data and patterns of vaccination confidence, willingness and coverage among HCWs nationwide. Results: In total, 2386 out of 2583 (92.4%) participants were enrolled for analysis, and the rates of confidence in vaccine, professional institutes and government were 75.1%, 85.2% and 85.4%, respectively. The overall vaccination coverage rate was 63.6% which was adjusted as 82.8% for participants under current medical conditions or having contraindications. Confidence in vaccine safety was shown to be the most related factor to willingness among doctors, nurses, medical technicians and hospital administrators, while confidence in vaccine effectiveness as well as trust in government played the key role in formulating public health employees’ willingness. 130 (7.1% of 1833) participants reporting willingness still not been vaccinated regardless of contraindications. Multivariate analysis among willingness participants showed that males, aged over 30 years, public health employees and higher vaccination confidence had significantly higher vaccination rates with ORs (95% confidence intervals) as 1.64 (1.08–2.49), 3.14 (2.14–4.62), 2.43 (1.46–4.04) or 2.31 (1.24–4.33). Conclusions: HCWs’ confidence, willingness and coverage rates to the vaccine were generally at high levels. Heterogeneity among HCWs should be considered for future vaccination promotion strategies. The population’s confidence in vaccination is not only the determinant to their willingness, but also guarantees their actual vaccine uptake.

Tailored intervention with peer-to-peer as a tool to promote childhood vaccination in migrants

Background A tailored intervention about childhood vaccination in Stockholm, Sweden, has focused on different activities with the aim to improve vaccination confidence and in particular Measles, Mumps and Rubella (MMR) vaccination coverage. The intervention included provided peer education focusing on vaccination information, the vaccine-preventable diseases, child development and communication skills in Somali and Swedish language and for the peers to further inform other parents in their communities. Aim This study aims to explore peers’ experiences of the interventions and their role to promote vaccination confidence. Methods This study follows a qualitative methodology with in-depth interviews and the data collection is ongoing. The study participants consist of seven peers who participated in the program. The interviews aimed to explore how the peers used the training in real life. All interviews conducted were tape-recorded and transcribed verbatim in order to facilitate deep content analysis. The analysis followed a content analysis, by first coding the data and then developing categories and emerging themes. Results Preliminary findings show that peers expressed the importance of having a training that equipped them with knowledge and confidence to discuss fact-based information with hesitant parents. The peers shared that after the training they had several opportunities to talk about childhood vaccinations in particular MMR vaccination with other parents. Some peers took an active role in reaching other parents by utilising the film and the cards to facilitate their dialogue. Other also acknowledged that when they could not answer a specific question, they encouraged the parents to address the query with the child health clinic nurses. Conclusions The use of a peer-to-peer concept to increase vaccination confidence provides additional forums for parents to dialogue about their concerns and receive correct vaccination information. Key messages Tailored interventions in close collaboration with communities are crucial for sustainable improvements of vaccination acceptance and coverage. The peer-to-peer concept provides a new arena to reach vaccination hesitant parents and can complement the communication on vaccination from health care provides.

Pre-post school educational intervention assessment on HPV vaccination attitudes and willingness

Background In Italy, vaccination coverage against human Papilloma Virus (HPV) showed a decreasing trend during last years. Different reasons could lead to a decrease in HPV vaccination confidence, such as not taking part to school seminars on HPV infection and vaccination. A pre-post intervention study was conducted in order to assess the improvement of knowledge, attitudes and behavior on HPV-related diseases and willingness on HPV vaccination among secondary school students. Methods Two anonymous pre-post intervention questionnaires made up of 25 and 8 items, respectively, were administered to a representative sample of students attending secondary schools of Palermo, Italy. Between the two questionnaire administration, an educational intervention on HPV-related diseases and HPV vaccination, conducted by Public Health medical residents at the University of Palermo, was carried out. Results During 2017/2018 and 2018/2019 school years, a sample of 1702 students, attending 18 first-grade secondary schools of the Province of Palermo, was enrolled. Evaluating a 10-scale likert question on the willingness of the children regarding vaccination against HPV, a significant increase of the average score from 8.50 (SD ± 1.79) to 9.01 (SD ± 1.50) (p value <0.001) was observed after intervention. At the multivariate analysis, male students (adjOR 1.76; 95% CI 1.28-2.42) and students attending schools in areas with a high deprivation index (adjOR 1.25; CI 95 % 1.01-1.55), showed a lower increase in HPV vaccination willingness after the educational intervention. In addition, 188 children from 5 schools of more deprived areas, not yet immunized, were vaccinated against HPV. Conclusions Standardized educational interventions in the school environment could increase confidence towards HPV and other vaccinations among students. Furthermore, vaccination offer at schools could represent a fundamental strategy to increase vaccination coverage, especially in more deprived areas. Key messages The research confirms the effectiveness of school educational interventions in increasing HPV vaccination confidence. Vaccination offer at schools could represent a fundamental strategy to increase vaccination coverage especially in more deprived areas.

Sample study protocol for adapting and/or translating the 5C scale to assess the psychological antecedents of vaccination

Background: Published in 2018, the 5C scale is psychometrically validated to assess five psychological antecedents of vaccination (confidence, complacency, constraints, calculation, and collective responsibility). The original version offers a validated English and German scale to assess these determinants with a short 5-item scale (1 item per antecedent) and a long 15-item scale (3-items per antecedent). As the original group of authors has received several requests about how to adapt the scale to another country, language, or cultural context, this sample study protocol provides guidance for this process. Here, we propose a two-phase process of how to adapt the 5C scale to a new country, language, or cultural setting. Methods: Phase 1 comprises the translation and the adaptation to a specific cultural context (if necessary). Phase 2 involves the validation of the translated and potentially expanded scale. Discussion: Following the suggested study protocol will allow better comparability across the data obtained from the scale when used in different countries, languages, and contexts—even if slight changes in the wording of the items are necessary. The data obtained from the 5C scale allows monitoring the antecedents of vaccination, and detecting potentially early warning signals. Consequently, data obtained from the 5C scale can support developing, implementing, and evaluating an intervention. The materials and the syntax for data analysis to support the process described in this protocol are available in https://osf.io/2agxe/.